A phase I trial of preoperative radiation, proctectomy, and endoanal reconstruction.
The purpose of this study was to explore the feasibility of sphincter preservation in abdominoperineal resection candidates by combining high-dose preoperative radiation therapy with restorative proctectomy through an endoanal anastomosis. Radiation to the pelvis was given using a three- or four-field technique to 4680 cGy (180 cGy/d) with portals from the top of S1 to 2 cm below the anus. The tumor bed received an additional 360-cGy boost. Four to 6 weeks after radiation therapy was completed, the patients underwent radical surgery. Phase I results for 14 patients are presented. All surgical specimens had negative distal and lateral margins. Surgical complications included one small-bowel obstruction requiring reoperation at 3 weeks, one pulmonary embolism, and one partial disruption (30% of the circumference) of the anastomosis. Bowel control and function were excellent in 8 and good in 4 patients. Function was not yet assessable in the remaining 2 patients.
Cohen
A M
AM
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021.
Minsky
B D
BD
D000230:Adenocarcinoma / Q000532:radiotherapy* / Q000601:surgery; D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000601:surgery*; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011183:Postoperative Complications; D011300:Preoperative Care; D012004:Rectal Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D012007:Rectum / Q000601:surgery*